The definitive answer to how a human contracted HIV and it progressed to AIDS was never definitive enough for far too many people, including healthcare professionals when I was a resident. A friend of mine had a niece who was a physician's assistant, and she was very much opposed to her applying for a position with an out-patient clinic that served HIV/AIDS patients not far from the hospital where I worked. She knew well my first year experience was almost exclusively on the AIDS unit and the Emergency Dept., and I told her of the abundance of safety precautions, etc. When she had enough, she just abruptly got up and walked out on me, stating what I imagined summarized the "risk analysis" of many: "She's not your niece."
Bill, this gets at something consent forms almost never solve: “low risk” changes tense after the injury.
Before the procedure, it means the choice is reasonable. After the complication, it can sound to the person harmed like: your pain was inside the acceptable margin. Same statistic, different room.
That is why these stories matter. They keep the complication from becoming either proof that the system is corrupt or proof that the patient should simply accept it. Sometimes the procedure was indicated, the clinician was competent, the consent was real, and someone was still hurt.
The detail of remembering the ski run stayed with me. Patients rarely see that part. The complication enters the chart, but it also enters the doctor's memory, with a place, a weather, a phone call, a sentence.
The cleanest language may be the least defensive: this was reasonable medicine, and it hurt you anyway. Both are true. Neither makes the other disappear.
“same stat, different room”— well put! When i did riskier procedures, i learned to tell families- “I might be coming out here with bad news. It is possible. Very unlikely, but possible. A couple times over many years, I did indeed come out with bad news. It helped to have framed it beforehand. thanks for your thoughtful comment.
That framing beforehand is the whole thing, isn't it. You can't change the statistic, but you can change which room the family is standing in when the bad news comes. Said after, "it was very unlikely" sounds like an excuse. Said before, the same sentence is you telling them the truth while you still had nothing to defend. Same words, and the timing is what makes one honest and the other defensive. The families who heard it beforehand got to keep you as someone who leveled with them, instead of someone explaining himself.
Your writing really resonates and I have some thoughts. I understand you realising exactly where you were when you heard the news about Mr G. These events remain burnt in our memory. It also paused and made me think how we communicate with colleagues. Your surgical colleague could possibly have provided you with the news in a softer way. Finally it made me think about how we consent people and complications. I have had very very few people choose not to have surgery because of potential complications. People struggle to fully understand risks presented as statistics and rightly so. A complication only matters if it happens to you. Those who get complications frequently develop amazing hindsight reporting that would never have had the procedure if they had known. The patients do know, they just forget. Sorry for my ramble. I enjoyed your piece and as a surgeon it made me think.
Indeed, Dr S didn’t exactly soften the blow- but actually i don’t think anyone could have. As an intensivist I have taken care of lots of surgical complications over the years- and tried to be a sensitive as I could— including absorbing some of the anger of family-but the event is the event.
And yes- my experience is that people are binary- they are either excessively afraid, or oblivious to risk. That’s why the mom at the end of my story was so remarkable.
The definitive answer to how a human contracted HIV and it progressed to AIDS was never definitive enough for far too many people, including healthcare professionals when I was a resident. A friend of mine had a niece who was a physician's assistant, and she was very much opposed to her applying for a position with an out-patient clinic that served HIV/AIDS patients not far from the hospital where I worked. She knew well my first year experience was almost exclusively on the AIDS unit and the Emergency Dept., and I told her of the abundance of safety precautions, etc. When she had enough, she just abruptly got up and walked out on me, stating what I imagined summarized the "risk analysis" of many: "She's not your niece."
Bill, this gets at something consent forms almost never solve: “low risk” changes tense after the injury.
Before the procedure, it means the choice is reasonable. After the complication, it can sound to the person harmed like: your pain was inside the acceptable margin. Same statistic, different room.
That is why these stories matter. They keep the complication from becoming either proof that the system is corrupt or proof that the patient should simply accept it. Sometimes the procedure was indicated, the clinician was competent, the consent was real, and someone was still hurt.
The detail of remembering the ski run stayed with me. Patients rarely see that part. The complication enters the chart, but it also enters the doctor's memory, with a place, a weather, a phone call, a sentence.
The cleanest language may be the least defensive: this was reasonable medicine, and it hurt you anyway. Both are true. Neither makes the other disappear.
“same stat, different room”— well put! When i did riskier procedures, i learned to tell families- “I might be coming out here with bad news. It is possible. Very unlikely, but possible. A couple times over many years, I did indeed come out with bad news. It helped to have framed it beforehand. thanks for your thoughtful comment.
That framing beforehand is the whole thing, isn't it. You can't change the statistic, but you can change which room the family is standing in when the bad news comes. Said after, "it was very unlikely" sounds like an excuse. Said before, the same sentence is you telling them the truth while you still had nothing to defend. Same words, and the timing is what makes one honest and the other defensive. The families who heard it beforehand got to keep you as someone who leveled with them, instead of someone explaining himself.
Your writing really resonates and I have some thoughts. I understand you realising exactly where you were when you heard the news about Mr G. These events remain burnt in our memory. It also paused and made me think how we communicate with colleagues. Your surgical colleague could possibly have provided you with the news in a softer way. Finally it made me think about how we consent people and complications. I have had very very few people choose not to have surgery because of potential complications. People struggle to fully understand risks presented as statistics and rightly so. A complication only matters if it happens to you. Those who get complications frequently develop amazing hindsight reporting that would never have had the procedure if they had known. The patients do know, they just forget. Sorry for my ramble. I enjoyed your piece and as a surgeon it made me think.
Indeed, Dr S didn’t exactly soften the blow- but actually i don’t think anyone could have. As an intensivist I have taken care of lots of surgical complications over the years- and tried to be a sensitive as I could— including absorbing some of the anger of family-but the event is the event.
And yes- my experience is that people are binary- they are either excessively afraid, or oblivious to risk. That’s why the mom at the end of my story was so remarkable.
Thanks for reading and engaging!